The additional value of radiology reports in the follow-up of extremity fractures: a retrospective study in an academic hospital

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-02 DOI:10.1016/j.jcot.2025.103043

Mare M.H. Walraven , Pieta Krijnen , David A. Vuijk , Monique Reijnierse , Inger B. Schipper , Marco F. Termaat

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引用次数: 0

Abstract

Background

Radiology reports on radiographic findings during follow-up (FU) after extremity fractures are generally not yet available when the patient is seen by the treating orthopedic trauma surgeon and may therefore be redundant. The aim of this study was to explore the inter-observer agreement on the reported findings of the FU radiograph between orthopedic trauma surgeons and radiologists.

Method

This retrospective cohort study included all FU radiographs of adult patients with an extremity fracture, treated in a Dutch university hospital between January 2022 and July 2023. The radiologist's and orthopedic trauma surgeon's assessments of unacceptable alignment, delayed/non-union and abnormalities associated with osteosynthesis material (OSM) on the FU radiographs were collected from the medical files. Fracture healing was considered normal in the absence of these findings. The interobserver agreement of the radiographic parameters between surgeon and radiologist was determined using Cohens' Kappa (κ). Additionally, incidental findings and their clinical relevance were explored.

Results

953 FU radiographs of 569 patients were included. The interobserver agreement was close to perfect for normal fracture healing (κ = 0.82, 95 % CI 0.77–0.88) and delayed/non-union (κ = 0.94, 95 % CI 0.89–0.99). The inter-observer agreement was substantial for unacceptable alignment of the fracture (κ = 0.80, 95 % CI 0.72–0.88) and abnormalities associated with the OSM (κ = 0.77, 95 % CI 0.65–0.89). Twenty-one incidental findings were diagnosed in the FU by the radiologist of which two were also independently described by the surgeon. Three of the findings that were missed or not described by the surgeon could have clinical significance, however the missing of these findings did not lead complications or additional hospital visits. These included two missed rib fractures and one osteochondral defect, which led to prolonged immobilization due to pain.

Conclusion

Radiographic reports in the FU of extremity fractures have limited additional value for clinical care and probably lacks cost-effectiveness or efficiency.

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影像学报告在四肢骨折随访中的附加价值：一所学术医院的回顾性研究

背景：当患者接受骨科创伤外科医生治疗时，四肢骨折随访（FU）期间的放射学报告通常尚未得到，因此可能是多余的。本研究的目的是探讨骨科创伤外科医生和放射科医生对FU x线片报道结果的观察者之间的共识。方法本回顾性队列研究纳入了2022年1月至2023年7月在荷兰某大学医院治疗的四肢骨折成人患者的所有FU x线片。从医学档案中收集放射科医生和骨科创伤外科医生对FU x线片上不可接受的对齐、延迟/不愈合和与骨合成材料（OSM）相关的异常的评估。在没有这些发现的情况下，骨折愈合正常。观察者之间对外科医生和放射科医生之间放射参数的一致性使用科恩斯卡帕（κ）来确定。此外，还探讨了偶然发现及其临床相关性。结果569例患者共953张FU片。对于正常骨折愈合（κ = 0.82, 95% CI 0.77-0.88）和延迟/不愈合（κ = 0.94, 95% CI 0.89-0.99），观察者间的一致性接近完美。观察者之间的一致性对于不可接受的骨折对齐（κ = 0.80, 95% CI 0.72-0.88）和与OSM相关的异常（κ = 0.77, 95% CI 0.65-0.89）是显著的。在FU中有21个偶然发现是由放射科医生诊断的，其中2个也是由外科医生独立描述的。外科医生遗漏或未描述的三项发现可能具有临床意义，但这些发现的遗漏不会导致并发症或额外的医院就诊。其中包括2例肋骨骨折和1例骨软骨缺损，由于疼痛导致长期固定。结论四肢骨折FU的影像学报告对临床护理的附加价值有限，可能缺乏成本效益或效率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.